When should you start on the pump?

Hello All.
After being DX T1 in DEC 2010 (previously DX T2 in 2006) The talk started about the pump. So I said sure have them ( pump reps) call me. My main concern was added monthly cost. After talking with them (Medtronics) they said it would be about an additional $120 per month. After sending them files via me and the Endo. I was denied by the insurance Co… Which I was ok with since my latest A1C was <7. And my feelings are if I wait maybe there will be some new pump on the market when I really needed one? But Medtronic did not give up. I found out this past Fri (05/13/11) that I have been approved. I am thinking WHAT? I thought it was a done deal no pump for now. So after searching this site for my answer to my question came up blank. I thought I would throw it out there. When should you consider going on a pump? Currently I take Lantus in the AM and Humalog at meal time. The shots are not a bother for now. I am seeing my Endo next week and will throw the question out to them as well but as we all know we have a better response and answers from our peers. Thanks for your time.

Hey Steve,
I was on MDI for about 8 years and didn’t really have a problem until a time when my control wasn’t nearly as consistent as it had been in the past. Though my A1c was only 7.2%, I was having lows and my post-prandial and fasting numbers were not consistent and I was having wide BG swings. I brought up the idea of a pump to my internist and he thought I was a good candidate. At that point, I had never seen an endo, even though I had been diabetic for over ten years. He insisted that I see an endo. I met with her and she agreed I would do well on a pump and, shall I say, the rest is history. I’ve been on the pump and CGM since last September. I’ve reduced my insulin needs to about 35% of what it was. My numbers are consistent and as I’ve lost weight (because of less insulin), my insulin has been reduced, both basal and bolus, and my lows are much less frequent. It has literally changed my life and the way I manage my diabetes. I use the Animas One Touch Ping. I really don’t know much about the Medtronic pump, though I did look at it before making my decision. I just liked the fact that the animas pump was water-proof and I loved their customer service and rep in my area.
Good luck!!!

Deciding to go on the pump was a big decision. It has been a little over a year now, I work very hard to make sure that I count every carb, test at every opportunity and self manage.

Before starting on the pump you should read a book Pumping Insulin, Walsh… If you don’t have a clear understanding on how to self manage, the pump will be very difficult to understand. It is important that you realize that it is you that still manages your diabetes. The pump is mearly a differant way on administering insulin. The pump does a better job of calculations, helps you keep track of what you have been doing as far as dosing and managing. You need to clearly understand that you will need to troubleshoot, You may test and find your BS at 400 and will need to follow a criteria to troubleshoot as to why? Was it food intake or mechanical.

It is expensive, and I have insurance. I budget for my pump with a Flex Spending Account at work. It helps me budget a certain amount money every paycheck to be set asside for supplies.

Sooo… your question was, When should I start on a pump?.. My suggestion is When you are able to successfully able to self manage. Start… When you can afford it. Start… And, when you are commmited to make an improvement in your control. Start. I wish you much success.

When is a good time? Honestly, it’s whenever you’re ready. When you’re ready for the additional education and knowledge it takes to use it. When you’re tired of the AM highs and the late-meal lows. When you’re at a stage in life that you’re not self-conscious having something taped down to your body and a device tethered to it. When you’re ready for TRUE flexibility. One thing I learned after switching from Lantus & MDI to a pump is that my basal rate is NOT the same throughout the day (nor is Lantus all that “flat” either), and that sometimes my Lantus covered meals, and other times my Humalog/Novalog covered my basal needs.

The best thing about getting off Lantus is that you’re not a slave to the 24 hours following the injection. Did you ever forget if you took your Lantus? I have. If I double-dose or skip a dose, it affects me for a full day, and then some. Did you ever have a particularly active day filled with hypos? With Lantus, you can’t go back to the previous night and dial-down your dose.

It sounds like you’re doing well, A1C wise. The fact that you’ve already looked into a pump in the past tells me you’re ready. If the finances work out, I’d say you should go for it. Maybe you see if you can borrow a pump for 30 days from your doctor to see if it works before making a huge financial investment.

Congratulations! It sounds like Friday the 13th turned out to be lucky for you!

That’s a great point regarding the Flexible Spending Account. If your job offers it, you can set aside the money to be deducted from your paycheck – PRE-TAX – to pay for it. Lets say, for the sake of the discussion, the pump itself costs $6000 out-of-pocket. That comes to $500 per month. If you sign up for an FSA for 2012, you can have $500 deducted from your paycheck every month throughout the year (which lowers your tax bracket as well) and get the pump in JANUARY, before you’ve fully paid for it. And if you happen leave your job in March, your employer - and not you - gets stuck with the balance.

I have gone on and off pump therapy and am back on it now. The best thing about having a pump is that it’s an option and you can always go back to MDI if you don’t like it or just want a break. I do this when I want to wear or do something that isn’t really conducive to wearing a pump.

Some things to consider - cost is definitely one factor. And keep in mind that you still need to get those pens and lantus to have as back-ups if your pump fails. So, yes, make sure to factor in cost.

If you’re happy on shots and have good control on them, you may want to wait on the pump. That said, you might find that the pump gives you some flexibility that you’ve been missing.

The pump definitely requires more “attention” than shots. This includes a significant learning curve (would highly recommend reading “Pumping Insulin” by Walsh) and an adjustment period. Also, you have to watch out because that increased freedom can, for some people, result in bad habits. It certainly did for me when I was younger!

You also have to be more on guard for DKA when on the pump. I experienced this firsthand 8 years ago and it was frightening (combination of failing to test after a late night out and a clog in my infusion set).

Getting set up on the pump is time consuming, so consider that as well. You may need/want to take some time off work, so perhaps starting during a period when you don’t have a lot going on in your life.

You need to be comfortable with gadgets. The pump is an electronic gadget and you have to learn how to troubleshoot it, because like everything, it will probably only fail when you are in a remote forest with no access to a cell phone (or something like that).

You also need to be comfortable at logging, tracking, and making small adjustments yourself. I tweak my basal rates a lot.

I’ve personally had a great experience with the Medtronic folks and I really like my Revel.

Speaking as someone who has had T1 for 36 years and has considered a pump many times, but always decided to stay with MDI, I have a somewhat perspective. I would say that you should start on a pump when you find that pumping provides some important advantage that MDI is unable to offer. For most people this is the ability to program basal rates that vary throughout the day, and for others it it the ability to instantly change their basal rates based on sudden activity or other circumstances. For example if you have a severe case of dawn phenomenon that you can’t seem to fix with your basal and bolus insulins, then that would be a reason to consider a pump. I have stayed with MDI since I don’t seem to have dawn phenomenon with my new basal schedule (Levemir twice a day) and am able to manage exercise without temporary changes to my basal rate.

I don’t think a pump will necessarily lower your A1c, so I don’t think that is a great reason for getting a pump. I was able to stay with MDI and lower my A1c by increasing testing a lot and by using that information to better tune my basal and bolus amounts (my basals and bolus ratios are far different than they were when I started). Figuring out how to adjust my basal and bolus was similar to learning how to adjust for a pump, but I had to do it on my own (using the Pumping Insulin and other books) since I didn’t have a pump trainer to help me through it.

At this point the only feature that would force me to reconsider and get a pump is when the pump and CGM are tied together into a semi-automatic artificial pancreas. THAT would be a big enough benefit to make me lose my reluctance.

Changes basal rates was a very big factor for me. I have a constant changing work schedule, changing energy levels through out the day. Lantus was there all the time and I had no control after it was injected. Yes, I agree it was not a straight level and it did not continue all day 24 hours.

Yeah, like Jag says, switch when you are comfortable with the idea of a pump. I switched after 25 years of MDI and it’s resulted in a modest increase in my BG control overall, as measured by my finger sticks and A1c, but a big boost in convenience because of my lifestyle. Different basal rates allow me more steady control than on basal and long acting nsulin.

I’m on the Omnipod and my insurance only pays 80% so I was under the impression that the Omnipod has the highest monthly costs and lowest up front costs while the traditional pumps have the highest up front costs and lower monthly costs. 20% out of pocket for the Omnipod means less than $100 monthly for me.

$120 a month for an MM seems a bit high. Is that the 100% out of pocket costs?

The $120 is $60 for pump and $60 for supplies. My insurance has a $2500 deduct. then 80/20 after that. I wish I could buy the pump up front. But with todays economy things are tight. Thanks for all of the info.

I agree w/ a lot of the other stuff about the pump, useful to adjust basal rates, etc. but the thing that is not in the marketing materials that was the most pleasant suprise for me is that it seemed to make diabetes a lot less work? For me, even telling the pump what my BG was, which then goes into the record in the pump that does a much better job logging my #s than I ever did, except during super crunch time when I had to log everything for a month to get the pump and, even then, my logs were a total mess. This is very useful for long term trends and the other side is that if you do want to make changes, your doc will likely request that you “send them some numbers” which basically requires you to act as your “unpaid diabetes secretary” for a few weeks to acquire data. Or you can slack off, in which case your doctor will likely be quite a bit less helpful. If you look at that time, even maybe twice a year or so that you want to make adjustments and pay yourself for say 40 hours/ week of secretarying, even at $10/ hour (a bit less than talented administrative assistants make around here but well, I’m trying to be conservative…), the pump will pay for itself in no time. I had a OneTouchUltraSmart that would compile quite a bit of data however it wasn’t nearly as useful as what I get out of the pump.

Another “labor” issue is that, at least for me, it seems to be quite a bit less time and work involved in “cleaning up” lower or higher BG. It’s not perfect, and there are still lots of challenges but it doesn’t take nearly as much time to keep my BG in line as it used to. I may not be the best example as I went from a perhaps hair-raising and entirely self-determined R/N regimen to a pump in 2008 (more bio garbage on my page if you want more details about the saga…) but despite the intimidating techno factor, it turned out to leave me more free time to do other stuff, which is also a clear <<win>> in my book. I’m not sure how pump manufacturers could market that aspect of it more effectively but that’s what the person I talked to about pumping (friend’s wife…) told me about it, I was skeptical but figured “what do I have to lose” and was pleasantly suprised to find that it exceeded my expectations.

Admittedly, there is money involved that may be a deal-breaker given the state of the economy but if you can swing it, you may find that it is more useful than you’d expected? I have learned a lot about fine tuning things with the pump that I would have attributed to “user error screw-ups” had I kept at MDI the way I had been.

Hi Steve: I was on MDI for three years, then started pumping 13 years ago (present pump, Animas 2020). For me, the pump really improved my situation. It is easier to exercise, it is quite convenient, once you get your basals set well it is not so much work, etc. I wouldn’t go back to MDI for anything! So when is it time? I wish I had done it sooner, so as long as you are willing to do the testing and put up with some “short term pain” for long term gain, I’d say go for it.

Thanks all there is some very good info on each of your own experiences. I visit my Endo on the 31st this month. I have a few more questions for them. Thanks again for all of the responses.